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目的 研究肝癌微转移的分布规律 ,为手术切除范围提供参考。方法 选择无临床转移灶的肝细胞癌病例 ,取切缘较充分的手术切除标本 36例 ,将其瘤周组织划分为近端区域和远端区域 ,制成病理大切片。在距原发灶边缘 0 .5 ,1.0 ,2 .0cm分别做 3条分界线 (L0 .5、L1.0 、L2 .0 ) ,把近端和远端区域的瘤周组织由内向外划分出 6组条带 (Zp0 .5、Zp1.0 、Zp2 .0 和Zd0 .5、Zd1.0 、Zd2 .0 )。分析微转移的扩散距离和各组条带的微转移密度 (Dp0 .5、Dp1.0 、Dp2 .0 和Dd0 .5、Dd1.0 、Dd2 .0 )。结果 检出的微转移 72 .5 %(111/15 3)是门静脉微癌栓。在 6 6 .7% (2 4/36 )的标本中检出了微转移 ,其中 91.7% (2 2 /2 4)的标本远端最大扩散距离 <3cm。在近端区域的特定分析中 ,92 .3% (12 /13)的标本近端最大扩散距离 <1.5cm。微转移密度比较 :Dp0 .5>Dp1.0 >Dp2 .0 ,Dd0 .5>Dd1.0 >Dd2 .0 ,Dd1.0 >Dp1.0 ,Dd2 .0 >Dp2 .0 ,差异有显著性。结论 (1)肝癌微转移主要以门静脉微癌栓的形式存在 ;(2 )距原发灶越远 ,微转移发生率越低 ;(3)在距原发灶 0 .5cm以外的范围 ,微转移在近端区域的发生率比在远端区域的低 ;(4 )对于无临床转移灶的患者 ,在远端切除瘤周组织范围达到 3cm ,在近端切除范围达到 1.5cm ,可能有助?
Objective To study the distribution of micrometastases in hepatocellular carcinoma (HCC) and provide a reference for the scope of surgical resection. Methods Thirty-six cases of hepatocellular carcinoma without clinical metastasis were selected. Thirty-six surgically resected specimens were collected and their peritumoral tissues were divided into proximal and distal regions to make large pathological sections. At the margin of 0 .5, 1.0, 2.0 cm away from the edge of the primary tumor, three boundary lines (L0.5, L1.0, L2.0, respectively) were made. The peritumoral tissues in the proximal and distal regions were divided from the inside to the outside Six groups of bands (Zp0 .5, Zp1.0, Zp2 .0 and Zd0 .5, Zd1.0, Zd2 .0) were produced. The diffusion distances of micrometastases and the microtransfer densities of the strips (Dp0.5, Dp1.0, Dp2 .0 and Dd0.5, Dd1.0, Dd2 .0) were analyzed. Results Micrometastasis was detected in 72.5% (111/15 3) of portal vein microthrombotic lesions. Micrometastases were detected in 66.7% (2/4/36) of the specimens, of which 91.7% (2/2/4) had a maximum distal diffusion distance of <3 cm. In the specific analysis of the proximal region, 92.3% (12/13) of the specimens had a maximum proximal diffusion distance of <1.5 cm. Micro-transfer density comparison: Dp0.5> Dp1.0> Dp2 .0, Dd0.5> Dd1.0> Dd2 .0, Dd1.0> Dp1.0, Dd2. 0> Dp2 .0, the difference was significant. Conclusions (1) Micrometastases of liver cancer mainly exist in the form of portal vein micro-tumor thrombus; (2) The farther away from the primary tumor, the lower the incidence of micrometastasis; (3) In the range of 0-5 cm away from the primary tumor The incidence of metastasis in the proximal region is lower than in the distal region; (4) For patients without clinical metastases, the excision of the peritumoral tissue in the distal region to 3 cm and the proximal excision to 1.5 cm may help ?